INCIDENCE OF ADVERSE CARDIOPULMONARY EFFECTS WITH LOW-DOSE CONTINUOUSTERBUTALINE INFUSION

OBJECTIVE: Our purpose was to determine the incidence of adverse cardi ovascular effects of terbutaline sulfate when administered as a contin uous subcutaneous infusion in women with arrested pretrem labor. STUDY DESIGN: Over a 6-year period records from 8709 women prescribed this therapy for preterm labor that had preivously been arrested with other intravenous tocolytics were reviewed. These women were assessed daily for cardiovascular complaints and tolerance of the medication, while either in the hospital or at the home (by telephone). The main outcome s studied were the occurrence of pulmonary edema, sustained cardiac ar rhythmias, chest pain, or myocardial ischemia. Any maternal death rega rdless of cause was also reviewed. RESULTS: Of the 8709 subjects, 47 ( 0.54%) had one or more cardiopulmonary problems. Pulmonary edema devel oped in 28 patients (0.32%) while receiving continuous subcutaneous in fusion of terbutaline, 5 at home and 23 in the hospital. Of the total, 17 women were being treated concurrently with large amounts of intrav enous fluids and one to three other tocolytic agents. In the 11 remain ing subjects, 4 were diagnosed with pregnancy-induced hypertension and /or multiple gestation. Nineteen patients experienced other adverse ca rdiovascular effects, including electrocardiogram changes, irregular h eart rate, chest pain, or shortness of breath. CONCLUSIONS: Continuous terbutaline infusion for women with stabilized preterm labor is assoc iated with much fewer adverse effects than previous literature regardi ng intravenous beta-adrenergic agonist therapy would suggest.